Çakin Özlem, Karaveli Arzu, Yüce Aktepe Melike, Gümüş Ayça, Yildirim Özlem Esra
Department of Internal Medicine Intensive Care Unit, Faculty of Medicine, Akdeniz University, 07070 Antalya, Türkiye.
Department of Anesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, 07070 Antalya, Türkiye.
J Clin Med. 2024 Jul 9;13(14):4011. doi: 10.3390/jcm13144011.
: The aim of the current study is to evaluate the effects of inflammation markers on infection and mortality in patients over 65 years of age monitored in the intensive care unit (ICU). In this study, we attempted to determine the significance of the pan-immune-inflammation value (PIV); the neutrophil-lymphocyte ratio (NLR); the platelet-lymphocyte ratio (PLR); the monocyte-lymphocyte ratio (MLR); the systemic immune-inflammatory index (SII); the systemic immune response index (SIRI); multi-inflammatory indices (MIIs) 1, 2, and 3; and the CRP/albumin ratio (a new biomarker) as prognostic and mortality markers in patients over 65 years of age being monitored in the ICU. : This multicenter, retrospective, cohort study was conducted on patients aged 65 and over who were admitted to two tertiary-level ICUs. Patients with cirrhosis, bone marrow transplantation, hematologic malignancy, steroid intake, current chemotherapy treatment, and neutropenia upon admission to the ICU were excluded from this study. : A total of 333 patients were included in this study. The group's 28-day mortality was found to be 31.8%. When each inflammatory marker associated with 28-day mortality was examined, the CRP/albumin ratio was found to be a better indicator than both the NLR and the SIRI, and the results were statistically significant (AUC: 0.665, 95% CI: 0.604-0.726, and < 0.001). The NLR showed moderate discriminative ability in distinguishing mortality risk (AUC: 0.593, 95% CI: 0.526-0.660, and = 0.006). Although the SIRI was lower than the NLR, it produced a statistically significant result (AUC: 0.580, 95% CI: 0.514-0.646, and = 0.019). The CRP/albumin ratio was the most effective inflammatory marker in predicting mortality risk in older patients admitted to the ICU. : It is important to monitor inflammatory markers (especially CRP/albumin ratio, NLR, SIRI, and MII 1-2-3) in older patients admitted to the ICU in order to accurately predict 28-day mortality. In the current study, the effects of PIV, MLR, PLR, and SII on the prediction of 28-day mortality in older ICU patients could not be demonstrated. We believe that more clinical studies are needed to determine the effects of PIV, MLR, PLR, and SII on short- and long-term prognoses and survival in older ICU patients.
本研究的目的是评估炎症标志物对重症监护病房（ICU）中65岁以上患者感染和死亡率的影响。在本研究中，我们试图确定全免疫炎症值（PIV）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）、全身免疫炎症指数（SII）、全身免疫反应指数（SIRI）、多种炎症指数（MIIs）1、2和3以及CRP/白蛋白比值（一种新的生物标志物）作为ICU中65岁以上患者预后和死亡标志物的意义。
这项多中心、回顾性队列研究是针对入住两家三级ICU的65岁及以上患者进行的。肝硬化、骨髓移植、血液系统恶性肿瘤、服用类固醇、当前接受化疗以及入住ICU时出现中性粒细胞减少的患者被排除在本研究之外。
本研究共纳入333例患者。该组的28天死亡率为31.8%。在检查与28天死亡率相关的每种炎症标志物时，发现CRP/白蛋白比值比NLR和SIRI都是更好的指标，结果具有统计学意义（AUC：0.665，95%CI：0.604 - 0.726，P < 0.001）。NLR在区分死亡风险方面显示出中等的判别能力（AUC：0.593，95%CI：0.526 - 0.660，P = 0.006）。虽然SIRI低于NLR，但也产生了具有统计学意义的结果（AUC：0.580，95%CI：0.514 - 0.646，P = 0.019）。CRP/白蛋白比值是预测入住ICU老年患者死亡风险最有效的炎症标志物。
对于入住ICU的老年患者，监测炎症标志物（尤其是CRP/白蛋白比值、NLR、SIRI和MII 1 - 2 - 3）对于准确预测28天死亡率很重要。在本研究中，未证明PIV、MLR、PLR和SII对ICU老年患者28天死亡率预测的影响。我们认为需要更多的临床研究来确定PIV、MLR、PLR和SII对ICU老年患者短期和长期预后及生存的影响。
